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Kiff, J A (2006d)
Paper 4:The psychology of clinical psychologists Joe Kiff, Dudley South PCT Introduction Critical Theory suggests that a number of factors contribute to our construction of reality. As we have seen, social and personal forces affect our clinical judgement and I have become interested in recent years in the individual differences between psychologists in this regard. In this paper I want to introduce a psychological perspective on these issues, with a particular focus on the personality of clinical psychologists, as an example of a post-modern, reflective analysis. To do this I want to adopt the model of Keirsey (1998) who has been explicit in linking the development of clinical approaches to the personalities of their founders. While the limitations of personality research are well documented (Millon & Davis, 1996) this work can provide a framework for thinking in this area. Keirsey’s Model Keirsey has studied personality and temperament for over fifty years and has developed a temperament theory (Keirsey, 1978) based on the widely used Myers-Briggs Type Indicator. By looking at how people use tools, either cooperatively or in a utilitarian way, and how they use words, whether abstractly or concretely, he assigns them to one of four groups. These types correspond broadly to Myers’ groups (Quinn et al 1992, Ruhl & Rodgers, 1992). Keirsey applies a name to each group and outlines their characteristics in the following terms (I have tried to reflect his words): * Artisans – concrete and utilitarian. ** Concrete Word Usage. Artisans talk mostly of what is going on currently, they spend little time considering things that cannot be observed or handled. This means they are likely to talk about things literally rather than figuratively. **Utilitarian Tool Usage. Artisans are primarily interested in what fits, what works, and only secondarily with what meets with social approval. They are not bothered with protocols or theories so much as with results. * Guardians – concrete and cooperative. ** Concrete Word Usage. In terms of word usage they talk for the most part about concrete particulars they observe in their material and social worlds. They might listen politely to conversation on theoretical topics but they tend not to reciprocate in kind and concentrate on concrete, solid, more sensible topics such as goods and services, clothes, prices and wages, the weather. ** Cooperative Tool Usage. Guardians work hard to make and enforce the laws that govern action, insisting that only by establishing and obeying rules and regulations will things get done properly. Cooperation, compliance, conformity and obedience loom large in their value system. * Rationals – abstract and utilitarian. ** Abstract Word Usage. In conversation Rationals try to avoid the irrelevant, the trivial and the redundant. They will not waste words, and while they understand that some redundancy is necessary they still are reluctant to state the obvious. Their tacit assumption is that what is obvious to them is obvious to others, and their overly terse and compact style of speech means it is sometimes hard for others to follow. The basis of coherence in Rational thought and speech is deductive inference. They are the ‘nitpickers’ and ‘hairsplitters’ who try and control definitions. ** Utilitarian Tool Usage. Rationals are particularly interested in efficiency as opposed to effectiveness per se. If a given operation promises to be too costly for the results it gets, that is inefficient though effective, they will look for operations that are likely to take less effort to get the same result. * Idealists – abstract and cooperative. ** Abstract Word Usage. Idealists talk little of what they observe: “of shoes and ships and sealing wax, of cabbages and kings” they talk instead of what can only be seen in the minds eye: love, hate, beliefs, possibilities, symbols, selves etc. They are inductive in their thought and speech, moving quickly from part to whole. They are sensitive to the hint of things, and often make inductive inferences, intuitive leaps that astonish others. Their thought and speech tends to be interpretive, which means they frequently comment on how one thing is really something else. Their communication is often laced with metaphors. Idealists can be highly sensitive to the nuances of communication that qualify messages, the body language, facial expressions and voice inflections which other types may not be aware of. ** Cooperative Tool Usage. Idealists emphasise consensus. They are suspicious of utilitarian actions, which go after results too coldly; they worry that the warm human touch will be lost, that good feelings will be sacrificed, and that unity will dissolve in a quest for expediency. Idealists dream of perfect interpersonal relationships, mutually supportive interactions lifted high above the fray of competition and contention. Discussion Keirsey’s contention is that different psychologists have promulgated theories that made sense to them at least in part because of their values and attitudes and personality as people (Keirsey 1998). For example, he writes of Maslow’s theory of Self–Actualisation: * "For if people are fundamentally different, born with different needs and inclinations, then they might not all share the desire to take Maslow’s last step into self-actualisation. Perhaps not even most of them. Of course all must have self-esteem. Maslow as right in this. But as it turns out, most people base their self-esteem on something else entirely. Only those of one particular temperament, Myers NFs, are concerned with becoming self actualised ……. Thus it is not that self-actualisation is a step beyond self-esteem; rather it is but one path to self-esteem. There are other paths. Freud, for instance, was right when he said that physical pleasure is the way. But not for everybody, as he supposed, and not as an end in itself, but as a means to self-esteem. Those of the SP temperament prize themselves more when they live sensually and hedonically. Harry Sullivan was also right. The security of social status is important – for some at least in the service of self-esteem. Those of the SJ temperament hold themselves in higher regard when they attain a reputation as pillars of society. Likewise, Alfred Adler was right in that the quest for power motivates us – some of us- and those of the NT temperament look upon themselves with pride as their technological powers increase. It is unfortunate that Maslow, himself an NF, saw the aims of the other three character types as merely arrested attempts at the NF goal of self-actualisation." Perhaps our own theory and practice is based on such personal assumptions. Unfortunately, as we have seen, science cannot get us out of this impasse – not least because its claim to objectivity and rationality is often, at some level, a personal preference of its proponents. If you are a rational, thinking, judging personality you would think science was a sound basis for action; if you are of an intuitive, feeling disposition you might want to qualify this view. On this basis the balance one strikes between reflection and science within our practitioner model may vary, at least in part, due to the clinician’s personality. Historically a ‘professional approach’ is one that denies the individual qualities of the professional. The notion here is that training is an activity that teaches a uniform approach to an area and where people’s values and attitudes are socialised into an acceptable mould. In the past people have been highly selected into the professions i.e. no women and black people, thus maintaining a particular identity. Individual differences were largely ignored in the belief that an orthodox view could be instilled into all. It will be clear from the argument so far that this is an outdated notion, reflecting a time when great swathes of the population were marginalized in order that white, heterosexual men could monopolise the spoils. We now live in a pluralist society and diversity is more valued. A proper ‘professional approach’ today is to know our values and assumption, to know the strengths and weaknesses that we bring to the job, to master the full range of tools required by our profession and to use them sensitively, creatively and appropriately within a more accepting, but boundaried, professional environment in which we are socially accountable for what we do. In clinical psychology (a largely white middleclass profession) it was once tacitly assumed that through clinical training most people would become scientist practitioners. In actual fact we know from the research that it is clear that the scientist practitioner model is no longer an appropriate construction of our professional identity. Within it’s own terms the contradictions are apparent. For example, most of us do not publish (Davey, 2002) and we do not read the literature (Law et al, 2004). Indeed we might argue that only a minority of psychologists have the personality to conduct their careers according to the socially constructed myth of the scientist practitioner. The addition of the reflective component to our identity is perhaps an appropriate recognition of our own pluralism in changing times. In thinking about the personal qualities we need to look for in recruiting reflective entrants to the profession I was struck by the professions lack of reflectivity in this area. While there is a literature looking at the personality of trainees in in various health profession, for example, dentistry (Morris 2000) and medicine (Bitran et al 2003), little is published on clinical psychologists. Yet amongst occupational psychologists, doing career assessments, there is an assumption that, that for example, the NF (intuitive feelers) are suited to work as psychologists. It is perhaps time that we worked more clearly with our occupational colleagues to develop more systematic recruitment and selection tools. Paying close attention to personality variables and honouring the differences between us can have benefits in other areas of our work. For example, where mismatches occur between clients and clinicians. The concrete thinking client seeking help sets a challenge to a metaphorically inclined, intuitive clinician. Just as the client with an intuitive understanding of a dreaming inner life is a challenge to a goal orientated, concrete thinking clinician. Understanding the systematic implications of these differences and amending our techniques accordingly is an important element of advanced clinical practice. Similarly appreciating the underlying personality characteristics of managers and other colleagues can lead to a more sophisticated appreciation of their values and goals and the development of more effective strategies for working with them. What are the implications of this for the tension between the scientist and reflective practioner paradigms? That is the subject of the next paper in the series. References * Davey, G. (2002) Clinical Research – worth our support. The Psychologist, 15(7), 331. * Keirsey, D. (1998). Please Understand Me II. Prometheus Nemesis. * Law, J., Banis, J. & Peck, D. (2004). The journal-reading habits of adult mental health clinical psychologists. Clinical Psychology 34, 36-40 * Millon,T & Davis, RD (1996). Disorders of personality: DSM IV and beyond. Wiley * Morris DO (2000). Personality types of dental school applicants. Eur J Dent Educ. 2000 Aug;4(3):p100-7 * Quinn M T, Lewis, R J & Fischer KL (1992). A cross correlation of the Myers-Briggs and Keirsey instruments. J of College Student Development, 1992, vol. 33, no. 3, p279-280. * Rezler AG & Buckley JM (1977). A comparison of personality types among female student health professionals. J Med Educ. 1977 Jun;52(6):p475-7 * Ruhl, DL & Rodgers RF (1992). The perceived accuracy of the 16 type descriptions of Myers and Keirsey : A replication of McCarley and Carskadon. J of Psychological type, 1992, vol.23 p. 22-26. * Sliwa JA & Shade-Zeldow Y (1994). Physician Personality types in physical medicine and rehabilitation as measured by the Myers-Briggs Type Indicator. Am J Phys Med Rehabil. 1994 Address Dr Joe Kiff, c/o Psychology Dept, Cross Street Health Centre, Cross St., Dudley, DY1 1RN. ; joe.kiff@dudley.nhs.uk Word count 1903